Recurrent Early Pregnancy Loss - 8 - Maintaining Hope

We have provided a lot of information over the past two weeks related to recurrent early pregnancy loss. Before we begin to translate that information into the medical evaluation that can be used to try to identify specific problem areas and possible approaches to ‘therapy’, let me digress for one day. I would like to mention several points that help to explain (not, necessarily, to justify) the response of providers (not all) to the subject of early pregnancy loss. Indeed, several readers have had comments related to these concerns and forgive me, but this is my way of addressing them in the most efficient manner…

Many providers will not even offer any medical evaluation to a woman until after she has had three or more early losses and has been classified, unflatteringly, as a “habitual aborter.” The reasons for this are multiple. First, there is truly a high spontaneous successful pregnancy rate, probably greater than 70%, in healthy women who have one, or even two, early losses. Secondly, early pregnancy loss is such a common problem (although most women do not know this and they certainly do not want to hear it) that a provider who has a busy obstetrical practice, has to confront this problem every day or two. Thirdly, as can be gathered by the multiple posts that I have written on the topic, this can be a complex issue that is not easy to cover in a short period of time and, because of these first three points, most providers do not feel it is practical, or necessary, to devote the time or the energy to what they consider to be a ‘self-limited’ condition. Unfortunately, they may also not be very good (or feel very comfortable) in conveying this information to their patients. (One should realize that because early pregnancy loss is such a common problem, it may also have affected the life of the provider who may prefer not to relive that experience with every patient).

The fourth point is that the ‘work up’ can be quite expensive (and may not be covered by insurance), nothing may be discovered, or something might be found for which no solution is readily available (such as a maternal or paternal chromosomal abnormality), oftentimes ‘empiric therapy’ is chosen regardless of what is found and, again, the patient may well carry the next pregnancy, whether or not any therapeutic regimen is implemented. And, finally, providers may either be unaware of, or reluctant to, refer the patient to a ‘specialist’ for fear of losing that patient from their practice.

Unfortunately, even if they are told these things (and oftentimes they are not, or they do not hear it because of their emotional condition at the time), this is not very satisfying to most women (couples) who experience the loss of a pregnancy. Indeed, I have seen many women in self-referral who swore they “would never return to that doctor” because what they did hear, the “Honey, you are young and healthy and just need to wait a few months and try again,” did not adequately address the questions and emotional needs she (they) had at that time. When I chat with women about this, mentioning the points above, they usually come away with some understanding (although often unforgiving) that the hurt, despair, guilt, and anger they feel over the loss of their baby is part of the ‘grieving process’ and shouldn’t necessarily be redirected at their provider; she (he) was only the messenger.

At the same time, by means of inquiry and explanation, it is important to identify potential problems, provide them with information, simple suggestions for what they can do on their own (even if a full ‘work up’ does not yet appear to be warranted), provide a detailed outline of a possible ‘work up’ if it does seem justified, try to dispel their feelings of guilt related to their loss(es), and above all, give them hope for the future. I always reassure them that in all the years I have been counseling and caring for patients with recurrent pregnancy loss, the ones who have not achieved a successful pregnancy can be counted on less than five fingers...

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